Uterine leiomyomata claim rate estimates and demographic characteristics by county. Florida, 2010-2019.

To describe the demographic characteristics and estimate the uterine leiomyomata claim rates (ULCRs) by women 18 years and older in Florida, we conducted a cross-sectional analysis of the 2010-2019 administrative claims for uterine leiomyomata and associated study variables (age, race, ethnicity, county of residence, anatomic site, length of stay, and additional diagnoses). ULCR ratios were estimated by race and ethnicity, using ULCR for non-Hispanic White women as the reference group. We identified 232,475 claims, most of which were among non-Hispanic White women in their forties. The overall ULCR estimate [95 percent CI] was 284.8 [284.21, 285.39] per 100,000 women 18 years and older, with a small, nonsignificant trend to increase over time (R2 = .310; p = .094). Black, Hispanic, and other women of color presented with higher ULCR ratios (4.84, 1.87, and 1.58, respectively). Urban counties had significantly higher ULCRs than suburban and rural counties. While non-Hispanic White women had the highest frequency of ULCRs, women of color-especially Black women-presented with significantly higher ULCR ratios. The epidemiologic profile of uterine leiomyomata in terms of age, race, ethnicity, and geographic location points to unmet healthcare needs among specific demographic and geographic groups of women in Florida.

The relationship between dietary inflammatory potential and cancer outcomes among cancer survivors: A systematic review and meta-analysis of cohort studies.

Cancer remains the second leading cause of death globally. Chronic inflammatory environments promote the growth of tumors, and the intake of certain food items can increase systemic inflammation. This study examined the relationship between the inflammatory potential of diet, measured by the Dietary Inflammatory Index (DII), and recurrence, all-cause, and cancer-specific mortality among cancer survivors. Web of Science, Medline, CINHAL, and PsycINFO databases were searched in April 2022. Two independent reviewers screened all searches. Of the 1,443 studies, 13 studies involving 14,920 cancer survivors passed all the screening stages. Three studies reported cancer recurrence, 12 reported all-cause mortality, and six reported cancer-specific mortality. Seven studies calculated DII from pre-diagnosis diets, five from post-diagnosis diets, and one from both pre-and post-diagnosis diets. A random-effects model meta-analysis showed that high DII was not associated with an increased risk of recurrence (HR = 1.09, 95 % CI = 0.77, 1.54, n = 4) and all-cause (HR = 1.08, 95 % CI = 0.99, 1.19, n = 14) and cancer-specific mortality (H = 1.07, 95 % CI = 0.92, 1.25, n = 6). Analysis by the timing of dietary assessment showed that only post-diagnosis DII was associated with an increased risk of all-cause mortality (HR = 1.34, 95 % CI = 1.05, 1.72, n = 6) by 34 %; however, cancer type did not modify these associations. The quality of the study assessed using the Newcastle Ottawa Scale indicated all but one studies were good. The risk of all-cause mortality among cancer survivors could be reduced by consuming more anti-inflammatory diets after cancer diagnosis.

Angina Outcomes in Secondhand Smokers: Results from the National Health and Nutrition Examination Survey 2007-2018.

Objective The aim of the study is to examine the relationship between secondhand smoke (SHS) and angina using the National Health and Nutrition Examination Survey database over a 12-year period. Methods Self-reported smoking status and cotinine levels were used to identify exposure groups (smokers, nonsmokers, and secondhand smokers), and medical history of angina was also collected via a self-report survey. The association between exposure to SHS and angina was analyzed using odd ratios with 95% confidence intervals calculated using two logistic regression models. Results The study found that when aggregating data from all 12 years, secondhand smokers are 42.9% significantly more likely to report having experienced angina, while smokers were 97.7% significantly more likely to report having angina compared with nonsmokers. Conclusions This study is the first of its kind to examine data from a national database over a 12-year period to determine an association between SHS and angina outcomes, thus highlighting the importance of reducing SHS exposure to improve cardiovascular health.

Monthly injectable cabotegravir/rilpivirine to manage HIV infection in adults.

ABSTRACT: The FDA recently approved a unique treatment regimen for management of HIV-1 infection in adults. A one-time per month injection of cabotegravir/rilpivirine can replace a current, stable antiretroviral regimen in those with virologic suppression, without history of treatment failure, or known or suspected resistance with cabotegravir or rilpivirine. A one-month oral trial should be initiated before switching to the extended-release injectable formulation. Cabotegravir/rilpivirine showed continued virologic suppression without clinically relevant changes in CD4+ cell counts. Clinicians should understand this new HIV regimen, its indications and suitability for select patients, administration and dosing, interactions, and most reported adverse events.

Caracterización del cáncer de mama en mujeres de Panamá

Objetivo: Caracterizar la edad y el perfil étnico/racial y el número de casos de cáncer de mama, las características del tumor y el tiempo de supervivencia entre las mujeres 2012-2016. Métodos: Este análisis secundario descriptivo aprovechó la información del Registro Nacional de Cáncer de Panamá. Resultados: Hubo 4134 casos de cáncer de mama con una edad media de 58años. La mayoría de las mujeres eran blancas (n=2514; 60,8%). Las regiones con más casos fueron Panamá (53,7%), Chiriquí (10,6%), Panamá Oeste (9,5%), Colón (6,6%) y Coclé (5,5%). Pocos (n=337) casos incluyeron datos desde el diagnóstico hasta la muerte para un tiempo de supervivencia que varió de 7.08 (Colón) a 17.08 (Panamá Oeste) meses. No se observaron diferencias estadísticamente significativas en los tiempos de supervivencia entre provincias. Pocos (n=1787) casos tenían datos de estadificación; El 15,1% estaba en estadio I, el 39,1% en estadio II, el 33,6% en estadio III y el 11,2% en estadio IV. La mayoría de los casos se clasificaron como T2 (7,1%) o T3 (7,1%). Conclusiones: La edad media y la raza del cáncer de mama es similar a la del hemisferio occidental. Las mujeres en Panamá tenían más probabilidades de ser diagnosticadas en una etapa más avanzada de la enfermedad, con solo el 15% diagnosticado con enfermedad en etapa I, con un tiempo de supervivencia que oscilaba entre 7,1 y 17,8 meses. Si bien la mayoría de los casos de cáncer de mama se encuentran en la provincia metropolitana de Panamá, la razón exacta de esto sigue sin estar clara. (provisto por Infomedic International)

Objective: To characterize the age and ethnic/racial profile and the number of breast cancer cases, tumor characteristics, and survival time among women 2012-2016. Methods: This descriptive, secondary analysis leveraged information from the Panama's National Cancer Registry. Results: There were 4134 cases of breast cancer with a mean age of 58. Most women were white (n=2514; 60.8%). The regions with the most cases were Panama (53.7%), Chiriquí (10.6%), Panama Oeste (9.5%), Colon (6.6%), and Coclé (5.5%). Few (n=337) cases included data from time from diagnosis to death for a survival time ranging from 7.08 (Colón) to 17.08 (Panamá Oeste) months. No statistically significant differences were observed in survival times between provinces. Few (n=1787) cases had staging data; 15.1% were StageI, 39.1% were StageII, 33.6% were StageIII, and 11.2% were StageIV. Most cases were classified as T2 (7.1%) or T3 (7.1%). Conclusions: The mean age and race of breast cancer is similar to that of the Western hemisphere. Women in Panama were more likely to be diagnosed at a more advanced disease stage, with only 15% diagnosed with StageI disease, with a survival time ranging between 7.1 and 17.8months. While most breast cancer cases are reportedly in the metropolitan province of Panamá, the exact reason for this remains unclear. (provided by Infomedic International)

Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis.

This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD -1.50 [-1.93, -1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox-a sustained catabolic state presenting with lower BMI-is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.

Assessing Health-Related Quality of Life Among Survivors of Testicular Cancer: A Systematic Review.

This study aimed to determine if the current health-related quality of life (HRQoL) tools created for survivors of testicular cancer are collecting the highest quality of data via a two-step methodological critique of both the seminal studies that produced a survivor of testicular cancer HRQoL tool (Phase 1) and the actual tool itself (Phase 2). It is the goal of this current article to present and discuss Phase 1.A systematic review aimed to assess the methodological quality of studies conducted to create instruments used to measure survivors of testicular cancer HRQoL. Five reviewers independently assessed each study with the 20-item Appraisal Tool for Cross-Sectional Studies (AXIS). Inter-rater agreement and Fleiss' kappa was also assessed to ensure consistency in reported scores. Assessments for the EORTC QLQ-TC 26 and CAYA-T studies were low (AXIS 52.5%; IRA 95%; κ = 0.779) and fair (AXIS 65%; IRA 80%; κ = 0.599), respectively. Critical appraisal of the scales included issues within the three core AXIS domains. Primary concerns related to sampling methodology and the lack of a qualitative component of their core conceptual development phase.Both reviewed seminal studies have significant methodological concerns that question the tools' quality. Next steps include extensive appraisal of the psychometric properties of the EORTC QLQ TC-26 and the CAYA-T to complete the comprehensive review. Accurate and reliable data are necessary to understand survivor of testicular cancer HRQoL and assist in building the bridge of communication between health care professionals and survivors to help to improve patient outcomes.

A Meta-Analysis of Blood Pressure Disparities Among Sexual Minority Men.

Purpose: The aim was to review and summarize reports on three measures of elevated blood pressure (BP) among sexual minority men (encompassing men who have sex with men [MSM] and both men and women [MSMW]), using men who have sex with women (MSW) as the reference population. Methods: Crude prevalence rates were calculated, and a meta-analysis was conducted to summarize the likelihood of elevated BP history, antihypertensive medication use, and elevated BP above a cutoff value, as well as the mean differences (MDs) in systolic BP (SBP) and diastolic BP (DBP) measurements. We used random effects to generate estimates with their respective 95% confidence intervals (CIs); alpha was set at 0.05. Results: Studies (n = 20) were published between 2007 and 2018, mostly in the United States. The likelihood of elevated BP history was not statistically significantly higher among sexual minority men, except when the measurement of sexual orientation was multidimensional (odds ratio [OR] 1.41, 95% CI 1.12-1.78). The likelihood of antihypertensive medication use was only statistically significantly higher for men who self-identified as MSMW (OR 1.44, 95% CI 1.11-1.85). When elevated BP was determined through a set cutoff, MSM were less likely (OR 0.34, 95% CI 0.16-0.70), whereas MSMW were more likely (OR 2.25, 95% CI 1.54-3.28) to have elevated BP. Although there were no statistically significant findings in the MD for SBP, the MD for DBP among sexual minority men was significantly higher (MD 1.46, 95% CI 1.38-1.55 mmHg) than among the MSW comparison group. Conclusions: Sexual minority men classified using a multidimensional approach to sexual orientation had a significantly higher likelihood of elevated BP history. Using BP cutoffs yielded opposite effects in MSM and MSMW. Although SBP was not different compared to MSW, DBP-a marker of hypertension at earlier ages-was elevated among sexual minority men.

Epidemiological Characteristics of Road Traffic Injuries Involving Children in Three Central American Countries, 2012-2015.

Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.

Parent reported outcomes to measure satisfaction, acceptability, and daily life impact after vaccination with whole-cell and acellular pertussis vaccine in Chile.

AIM: To compare parental satisfaction and impact on daily life among parents of children receiving whole-cell pentavalent + oral polio vaccine (Arm1) with an acellular hexavalent vaccine (Hexaxim; Arm2). METHODS: Self-administered electronic questionnaire at vaccination and one week later in six community health clinics of metropolitan Santiago, Chile, exploring parent-reported outcomes on satisfaction, acceptability, and impact on daily life after immunization. Univariate and multivariate analyses were conducted to determine differences in the responses in both groups (α = 0.05). RESULTS: The study enrolled 800 participants and 65% (222 in Arm1, 296 in Arm2) were included for according-to-protocol analysis. Demographic characteristics were comparable, except for a higher proportion of mothers answering the questionnaire at the 6-month visit. Regardless of the study arm, parental knowledge and perception of the immunization practices were good, and there were no differences in vaccination experiences in the prior 5 years. However, satisfaction with vaccination and intention to vaccinate were statistically significantly higher in Arm2 after the 6-month visit. Also, more parents in Arm2 reported no disruption in several aspects of the everyday activities of the parent, the child, and other children in the household. Parents in Arm2 were more likely to be satisfied with the vaccine received (OR 2.82; 95% CI, 1.22-7.07); return for other vaccine dose (OR 2.62; 95% CI, 1.45-4.84); follow a healthcare professional recommendation (OR 2.24; 95% CI, 1.57-3.21); and, to be confident that the vaccine will not disrupt the family's daily routine (OR 1.89; 95% CI, 1.32-2.71). CONCLUSIONS: Overall, satisfaction, intention for future vaccination, and lower impact on the family daily routine were significantly better in the group receiving the hexavalent vaccine. We also found that health care providers' recommendations to vaccinate and participants' access to health services were important factors favoring immunization.

Epidemiologic Characteristics of Suicide in Panama, 2007-2016.

Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007-2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = -0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20-29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

Use of electronic nicotine delivery systems (ENDS) in lesbian, gay, bisexual, transgender and queer persons: Implications for public health nursing.

Smoking and rates of tobacco abuse remain higher in lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons. There has been very little scholarly inquiry about the emerging trend of use of electronic nicotine delivery systems (ENDS; e.g., vaping and eCigarettes [eCigs]) in LGBTQ populations. The purpose of this article is to: (a) explore the most recent prevalence data regarding smoking and tobacco abuse in LGBTQ persons, (b) reveal strategies the tobacco industry has historically used in marketing their products to the LGBTQ community, (c) review data from the few studies evaluating use of ENDS in LGBTQ persons, (d) provide evidence-based methods public health nurses can employ to discourage use of ENDS in LGBTQ persons by addressing two identified causes of ENDS use in LGBTQ populations (harassment/discrimination in LGBTQ youth and binge drinking in LGBTQ adults), and (5) encourage cessation among those already using ENDS.

Prácticas al momento de la ablactación en Chitré, Herrera / Practices at the time of weaning in Chitre, Herrera

Resumen Introducción: Durante los años 90 en Panamá, un programa patrocinado por los EE. UU. llevo a cabo la Iniciativa para los Hospitales Amigos de los Niños (IHAN) como guía para educar a los profesionales clínicos, al público y a las mujeres en edad reproductiva sobre los beneficios de la lactancia materna. Como resultado, Panamá tiene actualmente la mayor proporción de mujeres que ofrece el pecho materno dentro de la primera hora de vida (89.9%), pero una de las menores tasas en la región de alimentación exclusiva al pecho materno hasta los 6 meses de edad. Este estudio explora la relación entre las practicas alrededor del periodo de ablactación y la historia nutricional del lactante en mujeres panameñas con un niño de hasta 1 año de edad utilizando un diseño transversal. Materiales y Métodos: Se invito una muestra por conveniencia de 35 binomios madre-hijo en dos Centros de Salud de Chitré, Herrera. Las mujeres que consintieron participar en el estudio completaron la Escala de Autoeficacia para la Lactancia Materna, Formulario Corto (BSES-SF) y se compararon las medidas antropométricas del niño utilizando los nomogramas de los CDC. Resultados: Los puntajes del BSES-SF variaron entre 29 y 56 (media = 44.2, DE = 7.9) puntos. Siete lactantes fueron considerados a riesgo para retraso en el Desarrollo; 40% estuvieron a riesgo de talla baja y 2 estuvieron a riesgo de sobrepeso. Conclusión: A pesar de que Panamá duplicó su cantidad de IHAN a 16%, muchos lactantes continúan a riesgo nutricional.

Abstract Introduction: In the 1990's, a U.S. sponsored program ran a campaign using the Baby-Friendly Hospital Initiatives (BFHI) as a guide to educate clinical professionals, the public, and women of child-bearing age in Panama about the benefits of breastfeeding. As a result, Panama has the highest proportion of women who breastfeed in the first hour of life (89.9%), but one of the lowest rates for breastfeeding at 6 months (UNICEF, 2014). This study explores the relationship between breastfeeding practices and infant nutritional history in Panamanian women with a child up to 1 year of age using a cross-sectional design. Materials and Methods: A convenience sample of 35 mother/baby dyads was recruited from two public health centers in the Azuero region of Panamá. Women who consented completed the Breastfeeding Self-Efficacy Scale, Short Form (BSES-SF), eight items from the Baby's Feeding and Health (BFH) instrument; and infant measurements were evaluated using the Centers for Disease Control standardized growth charts. Results: Breastfeeding Self-Efficacy Scale, Short Form scores ranged from 29 to 56 (mean = 44.2, SD = 7.9). Seven infants were at risk for developmental delay; 40% were at risk for short stature; 2 were at risk for overweight. Conclusion: Even though Panama has doubled its rate of Baby Friendly Hospitals to 16%, many infants remain at nutritional risk.

Hospital Variations in Unexpected Complications Among Term Newborns.

OBJECTIVES: To examine contributing factors and potential reasons for hospital differences in unexpected newborn complication rates in Florida. METHODS: We conducted a population-based retrospective cohort study of linked birth certificate and hospital discharge records from 2004 to 2013. The study population included 1 604 774 term, singleton live births in 124 hospitals. Severe and moderate complications were identified via a published algorithm. Logistic mixed-effects models were used to examine risk factors for complications and to estimate the percentage of hospital variation explained by factors. Descriptive analyses were performed to explore reasons for the differences. RESULTS: Hospital total complication rates varied from 6.7 to 98.6 per 1000 births. No correlation between severe and moderate complication rates by hospital was identified. Leading risk factors for complications included medically indicated early-term delivery, no prenatal care, nulliparity, prepregnancy obesity, tobacco use, and delivery in southern Florida hospitals. Hospital factors such as geographic location, level of care or birth volume, and Medicaid births percentage explained 35% and 27.8% of variation in severe and moderate complication rates, respectively. Individual factors explained an additional 6% of variation in severe complication rates. Different complication subcategories (eg, infections, hospital transfers) drove the hospital factors that contributed to severe and moderate complications. CONCLUSIONS: Variation in unexpected complication rates is more likely to be related to hospital rather than patient characteristics in Florida. The high proportion of variation explained by hospital factors suggests potential opportunities for improvement, and identifying specific complication categories may provide focus areas. Some of the opportunities may be related to differences in hospital coding practice.

Knowledge, Behavioral, and Sociocultural Factors Related to Human Papillomavirus Infection and Cervical Cancer Screening Among Inner-City Women in Panama.

Cervical cancer remains a leading cause of mortality in developing countries regardless of biomedical advances in prevention modalities. Specifically, Panama experiences one of the highest rates of cervical cancer worldwide. The objective of this study was to explore knowledge, behavioral, and sociocultural factors related to cervical cancer prevention among Panamanian women. A theory-guided, population-based quantitative survey following participatory processes was administered to a randomized sample of females (18-44 years) residing in a high-risk Panamanian community. Participants (n = 324) reported low knowledge regarding HPV, cervical cancer, and the purpose of the Pap test. Furthermore, low perceived susceptibility, high-risk sexual behaviors (e.g., low contraception and condom use) and adverse attitudes toward the Pap test (e.g., shame, fear) were identified. Television, newspapers/magazines, and relatives/friends/neighbors were common sources to receive health information. Significant gaps in knowledge and behavioral factors were identified, which may interfere with cervical cancer prevention efforts. Future strategies should reflect the sociocultural context, such as interpersonal relations, when developing and implementing cervical cancer programs, with the ultimate goal of decreasing the persistent burden among Latin American women.

Características epidemiológicas, clínicas y bioquímicas de los pacientes pediátricos con cetoacidosis diabética. Hospital de Especialidades Pediátrica Omar Torrijos Herrera 2003-2011

Introducción. La cetoacidosis diabética (CAD) es una complicación importante de la diabetes mellitus tipo 1 (DM1) que se presenta de novo o en pacientes ya diagnosticados, sin datos publicados en la literatura nacional. Objetivos. Describir las características epidemiológicas, clínicas y bioquímicas de los pacientes admitidos al Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) con diagnóstico de CAD. Métodos. Se realizó una revisión retrospectiva de los expedientes clínicos de los pacientes con diagnóstico de CAD admitidos a las salas de hospitalización del HEPOTH para describir las variables edad, sexo, glicemia, gravedad de la CAD, tiempo de resolución, complicaciones y uso de bicarbonato. Se utilizó estadística descriptiva (frecuencias, media y desviación estándar) y analítica con α=0.05 para cada comparación. Resultados. Encontramos 58 casos de CAD (28 masculinos, 30 femeninos). Observamos un pico bimodal de frecuencias entre los 8 y 11 años para ambos sexos. En el 62% de los casos no se encontró un factor evidente para la descompensación. Las variables metabólicas de todos los casos fueron evaluadas y se establecieron las medias (desviación estándar) de glicemia (530.9 [144.9]), bicarbonato (8.16 [3.58]) y pH (7.12 [0.12]). Se observó que, a mayor gravedad, menor valor de bicarbonato y de pH sanguíneo; además de una relación inversa, estadísticamente significativa (p<0.001) entre el pH al inicio del tratamiento con el tiempo requerido hasta alcanzar el pH de 7.30. La complicación más frecuente fue la hipokaliemia (44.8%). El edema cerebral ocurrió en 9% de los casos, de los cuales se registró una muerte (tasa de letalidad cruda = 1.7%). Conclusiones. La CAD es más frecuente entre los 8 y 11 años de edad y usualmente se presenta con criterios de gravedad. La hipokaliemia es la complicación más frecuente y el factor predisponente es difícil de detectar. A pesar de la baja letalidad encontrada, se debe vigilar por edema cerebral.

Background Diabetic ketoacidosis (DKA) is an important complication of type 1 diabetes mellitus, presenting either de novo or in patients already diagnosed, without data published in the national literature. Aims To describe the epidemiological, clinical, and biochemical characteristics of patients admitted to the "Omar Torrijos Herrera" Pediatric Specialties with diagnosis of DKA. Methods We performed a restrospective review of clinical records of patients diagnosed with DKA admitted to the wards of the Hospital to describe the variables age, sex, glycemia, DKA severity, time to resolution, complications, and use of bicarbonate. Descriptive (frequencies, mean, standard deviation [SD]) and analysitcal statistics were used with α=0.05 for each comparison. Results We found 58 cases of DKA (28 males, 30 females). We observed a bimodal peak of frequencies between ages 8 and 11 for both genders. In 62% of the cases there was no evident factor for the descompensation. Metabolica variables in all of the cases were assessed and mean (SD) of glycemia (530.9 [144.9]), bicarbonate (8.16 [3.58]) and blood pH (7.12 [0.12]) were established. The higher the severity, the lower bicarbonate and blood pH value; besides an inverse and statistically significant relationship (p<0.001) between pH at the beginning of the treatment and the time required to reach a blood pH value of 7.30. The most frequent complication was hypokalemia (44.8%). Cerebral edema occurred in 9% of the cases, among which one decease was registered (crude lethality rate = 1.7%). Conclusions Diabetic ketoacidosis is more frequent between 8 and 11 years of age and usually presents with severity criteria. Hypokalemia is the most frequent complication and the predisposing factor is difficult to detect. Even though we found a low lethality rate secondary to cerebral edema, this complication must be always beared in mind.

Conocimiento y actitudes de los residentes de pediatría de Panamá las recomendaciones internacionales para la inmunización de los adolescentes: Evidencia para un cambio curricular

Introducción: Con miras a mejorar el programa panameño de residencia pediátrica (PPRP), se recolectaron y analizaron los datos iniciales sobre el conocimiento y actitudes de los residentes hacia las recomendaciones internacionales para la inmunización del adolescente. Materiales y Métodos: A través de un instrumento anónimo de recolección de datos y validado para este estudio transversal, se recabaron los datos demográficos, de conocimiento y actitudinales. El conocimiento se midió como el porcentaje de respuestas correctas a 50 preguntas de selección múltiple. Las actitudes se evaluaron en una escala tipo Likert. Los análisis estadísticos (α = .05) incluyeron medidas descriptivas y comparativas. Resultados: A nivel nacional, 33 residentes (64% femeninos; 11 en cada año de residencia) aceptaron participar (tasa de respuesta = 53%, poder post hoc = 69%). Excepto por el conocimiento sobre las definiciones y conceptos generales de las inmunizaciones (76.7%), cada dominio del conocimiento fue menor a 50%. Los puntajes de conocimiento para diez vacunas específicas variaron entre 20.8% y 56.5%. Ninguna de las variables demográficas evaluada estuvo significativamente asociada con los puntajes de conocimiento. La mayoría de los residentes (95.7%) está de acuerdo con la importancia del tema y muy pocos (14.6%) reconocen tener su ciente experiencia previa con el mismo. Las formas para obtener esta experiencia propuestas por los residentes serían dentro del programa de residencia (71.8%) o a través de estudio independiente (61.5%). Conclusiones: Los residentes en el PPRP carecen de un conocimiento adecuado sobre las prácticas de inmunización recomendadas para los adolescentes, probablemente por exposición insuficiente a este contenido; sin embargo, mostraron actitudes positivas para aprenderlo durante el programa de residencia.

Introduction: International professional groups advocate for a specialized training in adolescent medicine, but these desirable general competences should not escape trained pediatricians. The Panamanian pediatric residency program (PRPP) is a standardized curriculum for the training of pediatricians countrywide and will include a module on adolescent health. Baseline data on pediatric residents' current knowledge and attitudes toward international adolescent immunization recommendations was collected to guide the curricular enhancement process. Methods: Demographics, knowledge, and attitudes were collected through a voluntary, anonymous survey instrument previously validated for this cross-sectional, observational study. Knowledge was measured as the percentage of correct answers to 50 multiple-choice questions. Attitudes were assessed in a Likert-type scale. Statistical analysis (α = .05) included descriptive and comparative measures. Results: Nationwide, 33 residents (12 males, 21 females; 11 in each year of residency) agreed to participate, for a 53% response rate and 69% post hoc power. Except for the knowledge score about immunization definitions and general concepts (76.7%), every knowledge score was below 50%. Knowledge scores for ten specific vaccines ranged from 20.8% to 56.5% for meningitis and chicken pox, respectively. None of the demographic variables assessed was statistically significantly associated with increased knowledge scores. Most residents (95.7%) agree with the importance of the topic, and very few (14.6%) acknowledge a sufficient previous experience with it. The formats for gaining experience in these topics most agreed upon were the residency program itself (71.8%) and independent study (61.5%). Discussion: The current PPRP trainees lack adequate knowledge on the immunization practices recommended for adolescents. The residents corroborated an insu cient exposure to knowledge on these practices, with very positive attitudes to learn them through a module within the residency program, to be considered in the new PPRP curriculum.

Vasculitis de Churg-Strauss: Sin historia de asma en una escolar Ngöbe Buglé

La vasculitis de Churg-Strauss es una entidad clínica poco frecuente que rara vez se reporta en niños. Es una vasculitis difusa rara que casi invariablemente se acompaña de asma grave y eosinofilia. La presentación clínica de la enfermedad depende del estadio y del uso previo de corticoides. A pesar de que el pronóstico global es bueno y el tratamiento con prednisona sola o en combinación con agentes inmunosupresoras es exitoso en general típicamente el asma grave persiste. La causa de la vasculitis de Churg-Strauss todavía se desconoce, pero los hallazgos histopatológicos característicos y su asociación con el asma lo distinguen de las otras vasculitis. El caso clínico que presentamos demuestra que el asma no siempre está presente y que una eosinofilia marcada y persistente debe despertar la sospecha diagnóstica de la VCS.

Churg-Strauss vasculitis is a rare clinical entity rarely reported in children. It is a rare diffuse vasculitis that almost invariably is accompanied by severe asthma and eosinophilia. The clinical presentation of the condition depends on the clinical stage and the previous use of steroids. Even though the global prognosis is favorable and the treatment with prednisone alone or in combination with immunosuppressive agents is generally successful, severe asthma typically persists. The cause of Churg-Strauss vasculitis is still unknown, but the characteristic histopathological findings and their association with asthma distinguish this from all other vasculitis. The clinical case we present demonstrates that asthma is not always and that a severe, persistent eosinophilia must make the clinical suspect of Churg-Strauss vasculitis.

Características del accidente por ingestión de cuerpo extraño en la población pediátrica

Introducción : El accidente por ingestión de cuerpo extraño es un problema importante en la población pediátrica. Se investigaron sus características en el Hospital de Especialidades Pediátricas Omar Torrijos Herrera (HEPOTH). Objetivos: Describir las características del accidente por ingestión de cuerpo extraño en la población pediátrica asegurada atendida en el HEPOTH y compararlas con la literatura nacional e internacional. Materiales y métodos: Estudio descriptivo retrospectivo en todos los pacientes pediátricos asegurados admitidos al HEPOTH el diagnóstico de cuerpo extraño en la vía digestiva desde julio de 2004 hasta junio de 2008. Resultados: Ciento cincuenta casos ( 82 masculinos, 68 femeninos) cumplieron los criterios de inclusión. La edad promedio 3.19 (0.42 -12.85) años. Los sitios de alojamiento fueron esófago, estómago y colon en su mayoría. Los síntomas de presentación fueron sialorrea (32.7%) , vómitos /náusea y disnea; 36.7% cursaron asintomáticos. Los cuerpos extraños más frecuentes fueron monedas ( 60.7%) , baterías de botón y joyas (9.3% cada uno) . Se realizó endoscopio en 71.3% de los casos y la complicación más frecuente fue la laceración esofágica. Conclusión: El accidente por ingestión de cuerpo extraño en la población pediátrica asegurada tiene características propias, distintas a las descritas en la población no asegurada y en la literatura internacional que requieren atención al momento de su manejo.

Introduction: Foreign body ingestion accident is an importan problem in the pediatric population. We researched its characteristics in the Omar Torrijos Herrera Pediatric Specialties Hospital (HEPOTH). Aims: To describe the characteristics of foreign body ingestion accident in the insured pediatric population that attends the HEPOTH and compare them with national and international literature. Material and methods: Descriptive retrospective study in all the insured pediatric patients admitted to HEPOTH with the diagnosis of foreign body in the digestive tract from july 2004 until june 2008. Results: One hundred fifty cases ( 82 males , 68 females) fulfilled the inclusion criteria. Average age was 3.19 (0.42 -12.85) years. Lodging sites were esophagus, stomach, and colon mostly. The most frequent presentation symptoms were syalorrea (32.7%) vomits/nausea, and diarrhea; 36.7% were asymptomatic. Most frequent complication was esophageal laceration. Conclusion: Foreign body ingestion accident in the insured pediatric population has its own characteristics, distinctive to those described in the non-insured population and in the international literature, which require attention when managing it.